Out-of-hospital assessment and triage of paracetamol (acetaminophen) exposure in the United States and Canada: a consensus guideline.

Introduction: Consensus guidelines for out-of-hospital assessment and triage of paracetamol (acetaminophen) exposure were published in 2006. Changes in the healthcare system, paracetamol ingestion trends, and availability of paracetamol-containing products necessitate an update to these guidelines. Updated guidelines were created for out-of-hospital management of paracetamol exposure in the United States and Canada.

Comparison of children receiving extracorporeal treatments for poisoning at United States centers with and without a pediatric nephrologist.

Background: Pediatric nephrologists are rare in the United States; many children with poisoning needing extracorporeal treatments may not have timely access to care. This study compared outcomes in children receiving extracorporeal treatments for poisoning at centers with and without a pediatric nephrologist.

Methods: This was a retrospective cohort study of all patients aged ≤17 years reported to an American poison center covering three upper midwestern states during 2000-2024.

Sotalol poisoning and its unique treatment considerations compared with traditional therapies for beta-adrenoceptor blocking drug poisoning.

Introduction: Sotalol is a beta-adrenoceptor blocking drug with unique physical and pharmacologic properties. Unlike most beta-adrenoceptor blocking drugs, sotalol is amenable to extracorporeal removal and causes QT interval prolongation and ventricular dysrhythmias. These properties have implications for treating sotalol poisoning.

Should digoxin immune fab be administered based solely on reported ingested amount in acute digoxin poisoning?

Acute digoxin poisoning is increasingly uncommon in emergency medicine. Furthermore, controversy exists regarding indications for antidotal digoxin immune fab in acute poisoning. In healthy adults, the fab prescribing information recommends administration based on "known consumption of fatal doses of digoxin: ≥10mg," while many emergency medicine textbooks suggest fab administration be driven by clinical features or potassium concentration.

Regional readiness for sodium nitrite-induced methemoglobinemia: availability of methemoglobin testing and methylthioninium chloride (methylene blue) stocking in the Upper Midwestern United States.

Introduction: Sodium nitrite is a potent oxidizer, which may precipitate rapidly lethal methemoglobinemia. Prompt diagnosis and treatment may salvage otherwise fatal cases. It is unclear if emergency departments are prepared for increasing cases.

Disentangling the temporal relationship between alcohol-related attitudes and heavy episodic drinking in adolescents within a randomized controlled trial.

Background And Aims: Within many alcohol prevention interventions, changes in alcohol-related attitudes (ARA) are often proposed as precursors to changes in drinking behaviour. This study aimed to measure the longitudinal relationship between ARA and behaviour during the implementation of a large-scale prevention trial.

Design And Setting: This study was a two-arm school-based clustered randomized controlled trial.

Acute kidney failure from ingestion of "wood bleach" beekeeping miticide.

Wood bleach is >95 % oxalic acid formulation used off-label as a miticide for Varroa mites by hobbyist beekeepers. Wood bleach (oxalic acid) ingestions are poorly documented in the medical literature. A 46-year-old man presented to the emergency department nauseated and vomiting after accidentally ingesting "bleach and grain ethanol intended for use in beekeeping.

Developments in the epidemiology of calcium channel blocker poisoning and implications for management.

Purpose Of Review: The aim of this study was to outline recent developments in calcium channel blocker (CCB) poisoning. The dihydropyridine CCB amlodipine is commonly prescribed in the United States, and amlodipine poisoning is increasing in frequency, presenting new challenges for clinicians because current paradigms of CCB poisoning management arose from literature on non-dihydropyridine agents.

Recent Findings: Amlodipine is now the most common CCB involved in poisoning.

Physostigmine reversal of delirium from second generation antipsychotic exposure: a retrospective cohort study from a regional poison center.

Introduction: Physostigmine is an effective antidote for antimuscarinic delirium. There is little evidence for its use to reverse delirium following second generation antipsychotic exposure. The purpose of this study is to describe the safety and effectiveness of physostigmine in reversing delirium from second generation antipsychotic exposure.

Comparing Intubation Rates in Patients Receiving Parenteral Olanzapine With and Without a Parenteral Benzodiazepine in the Emergency Department.

Study Objective: United States prescribing information recommends against coadministration of injectable olanzapine with injectable benzodiazepines due to a risk of cardiorespiratory depression, whereas European prescribing information recommends the 2 drugs not be administered within 60 minutes of each other. In contrast, a recently published American College of Emergency Physicians clinical policy recommends injectable olanzapine and benzodiazepines be coadministered for treating severe agitation. We sought to compare injectable olanzapine with and without injectable benzodiazepines for evidence of cardiorespiratory depression.

Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis.

Objectives: Occupational moral injury and post-traumatic embitterment disorder (PTED) describe the psychological distress caused by exposure to injustice at work. This meta-analysis aims to determine the prevalence of occupational moral injury and PTED and establish whether prevalence estimates differ depending on occupation.

Design: A systematic review and meta-analysis.

American College of Medical Toxicology and the American Academy of Clinical Toxicology position statement: nalmefene should not replace naloxone as the primary opioid antidote at this time.

Background: Nalmefene is a potent opioid antagonist that has recently been reintroduced in the United States to treat known or suspected opioid overdose.

Nalmefene Clinical Trial Data: The injection formulation, which had been withdrawn in 2008, was reintroduced in 2022, and in 2023 the United States Food and Drug Administration approved a new intranasal formulation of nalmefene. Because nalmefene had been previously approved for use in 1995 via injection, the new intranasal formulation did not require new clinical data as it was approved under an Abbreviated New Drug Application.